[Lactic acidosis in a child with acute severe asthma]

Area of Science:

• Pediatric Intensive Care Medicine
• Respiratory Medicine
• Emergency Medicine

Background:

• Lactic acidosis is a known complication in adults with acute severe asthma (ASA).
• Pediatric cases of lactic acidosis associated with ASA are infrequently reported.
• Early recognition and management are crucial for pediatric patients with ASA.

Observation:

• A 2-year-old girl presented with ASA requiring high-flow oxygen, intravenous methylprednisolone, and salbutamol.
• During treatment, she developed metabolic acidosis, hypocapnia, elevated anion gap, and high lactate levels.
• Congenital metabolic disease work-up yielded normal results.

Findings:

• The patient exhibited significant lactic acidosis (lactates 8 mmol/L) and metabolic acidosis (pH 7.29, bicarbonate 12 mmol/L, anion gap 20 mmol/L).
• The lactic acidosis resolved spontaneously within 72 hours of intensive care.
• The multifactorial origin of lactic acidosis in ASA was suggested.

Implications:

• Lactic acidosis in pediatric ASA, though rare, requires clinical awareness.
• Prompt identification can prevent potential worsening of respiratory status and unnecessary treatment escalation.
• This case highlights the importance of monitoring metabolic parameters in critically ill children with severe asthma.